养阴明目饮Ⅰ号方联合前列地尔注射液治疗糖尿病视网膜病变肝肾阴虚证临床研究

Clinical Study on Yangyin Mingmu Yin No.I Prescription Combined with Alprostadil Injection for Diabetic Retinopathy with Liver-kidney Yin Deficiency Syndrome

目的:观察养阴明目饮Ⅰ号方联合前列地尔注射液治疗糖尿病视网膜病变(DR)肝肾阴虚证的临床疗效及对血清胱抑素C(Cys-C)、视黄醇结合蛋白4(RBP4)、单核细胞趋化因子-1(MCP-1)、细胞间黏附分子-1(ICAM-1)水平的影响。方法:选取74例DR肝肾阴虚证患者,按随机数字表法分为对照组和观察组各37例。对照组给予前列地尔注射液静脉滴注,观察组在此基础上联合养阴明目饮Ⅰ号方内服,2组均连续治疗2个月。对比2组临床疗效,观察患者治疗前后眼部指标、视网膜血流动力学及外周血细胞因子水平的变化。结果:总有效率观察组91.9%,对照组73.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组眼部血管瘤体积、视野灰度值、黄斑厚度、出血斑面积均较治疗前改善(P<0.05);观察组上述各项指标改善情况均优于对照组(P<0.05)。治疗后,2组视网膜中央动脉收缩期峰值流速(PSV)、舒张末期流速(EDV)、平均血流速度(Vm)值均较治疗前提升(P<0.05),视网膜中央静脉回流速度(CRV),视网膜中央动脉血流阻力指数(RI)、搏动指数(PI)值均较治疗前减小(P<0.05);观察组PSV、EDV、Vm值均大于对照组(P<0.05),CRV、RI、PI值均低于对照组(P<0.05)。治疗后,2组Cys-C、RBP4、MCP-1、ICAM-1水平均较治疗前降低(P<0.05);观察组上述4项指标水平均低于对照组(P<0.05)。结论:养阴明目饮Ⅰ号方联合前列地尔注射液能减轻DR肝肾阴虚证患者的眼底病变症状,其作用机制可能与改善视网膜局部血液循环、减轻视网膜局部炎性损害有关,值得临床借鉴。

Objective:To observe the clinical effect of Yangyin Mingmu yin No.I prescription combined with alprostadil injection for diabetic retinopathy(DR) with liver-kidney yin deficiency syndrome,and its effect on levels of serum Cystatin C(Cys-C),retinol binding protein 4(RBP4), monocyte chemotactic protein-1(MCP-1) and intercellular adhesion molecule-1(ICAM-1). Methods:Selected 74 cases of patients with DR with liver-kidney yin deficiency syndrome, and divided them into the control group and the observation group randomly, 37 cases in each group. The control group received alprostadil injection via intravenous drip, while the observation group additionally received Yangyin Mingmu yin No.I prescription via oral administration. The treatment of both groups lasted for 2 months continuously. Compared the clinical effect in both groups, and observed the changes in ocular indexes, retinal hemodynamics and levels of cytokines in peripheral blood before and after treatment. Results:The total effective rate was 91.9% in the observation group and 73.0% in the control group, difference being significant(P < 0.05). After treatment, the volume of ocular hemangioma, grayscale value, macular thickness and the area of blood spots in both groups were respectively improved when comparing with those before treatment(P < 0.05);each index in the observation group was improve better than that in the control group(P < 0.05). After treatment, the peak systolic velocity(PSV), end diastolic velocity(EDV) and Vm in central retinal artery in both groups were higher than those before treatment(P < 0.05),and the central retinal vein reflux velocity(CRV),resistance index(RI) and pulsatility index(PI) were lower than those before treatment(P < 0.05);the values of PSV,EDV and Vm in the observation group were higher than those in the control group(P < 0.05),and the values of CRV,RI and PI were lower than those in the control group(P <0.05). After treatment,the levels of Cys-C, RBP4, MCP-1 and ICAM-1 in both groups were lower than those before treatment(P <0.05);the levels of these four indexes in the observation group were lower than those in the control group(P < 0.05). Conclusion:Yangyin Mingmu yin No.I prescription combined with alprostadil injection can alleviate ocular fundus diseases in patients with DR with liver-kidney yin deficiency syndrome. Its functional mechanism may be related to improving retinal local blood circulation and reducing retinal local inflammatory injuries,which is worthy of clinical reference.